POS0087-PARE IMPROVED SELF-MANAGEMENT IN PATIENTS WITH OSTEOPOROSIS AND INFLAMMATORY ARTHRITIS
Authors: M. Roffler, A. Mueller, I. Steeb
Journal: Annals of the Rheumatic Diseases (2022)

Background Self-management care services have received a great deal of attention in Switzerland lately. However, there is still a huge gap in service provision, especially with regard to rheumatic diseases. To fill this gap, the Swiss League against Rheumatism has developed a comprehensive self-management programme for patients with inflammatory arthritis (IA) and osteoporosis. In the course of this programme, eleven medical assistants in outpatient rheumatological and general practitioner clinics were trained to help osteoporosis and IA patients to strengthen their self-management capacity. This programme was implemented within the scope of a three-year pilot project (2019 – 2021) and is continuing as a regular project from 2022 onwards. Objectives The ultimate objective was to increase the quality of life and health status of people with osteoporosis and IA by enhancing their capacity for self-management. This included all three components of self-management, i.e. strengthening patients’ knowledge of the disease, motivating them to take action and increasing their ability to manage the disease. Furthermore, the pilot project aimed to close an important gap in the Swiss health care system. Methods A questionnaire was designed to measure the change in self-management abilities and the health status of patients. The questionnaire was given to patients at three points in time (t1=enrolment of patient, t2=last session of the self-management programme and t3= two months after the last session) and contained several validated scales such as the heiQ, Self-Efficacy for Managing Chronic Disease 6-Item Scale, RADAI-5 and EQ-5D-5L. Descriptive statistics were applied to analyse the data by comparing the mean values of all relevant indicators at three points in time. Results In total 52 patients were enrolled in the pilot project. 48 patients completed the programme and 35 took part in the follow-up questionnaire. Overall, the results show a positive trend in self-management abilities and an improvement in the patients’ current health status. The slight increase in knowledge remained until the follow-up. Significant changes are seen in Skill and Technique Acquisition as well as in Self-Monitoring and Insight of the disease, which are two important components of self-management. Other components such as the knowledge and constructive attitudes and approaches also underwent a small but positive change that lasts up to two months after the last session of the self-management programme. Self-efficacy improved as well, but with a slight decrease during the follow-up. The disease activity also declined slightly over time. The results also indicate a small and steady improvement of the current health status . Using a visual analogue scale as part of the EQ-ED-EL, participants evaluated their current health status as 69 (t=1), 73 (t=2) and 74 (t=3). The quality of life has improved too, but the change doesn’t seem to be relevant. Furthermore, the use of health services indicates a slight decline after taking part in the self-management programme. Conclusion The comprehensive self-management programme designed by the Swiss League against Rheumatism embedded in outpatient rheumatological and general practitioner clinics proved to be successful. The three components of self-management in particular, i.e. knowledge, motivation to take action and skills to manage the disease improved significantly. The results also show a positive trend in the patients’ current health status, their quality of live and a decline in disease activity. However, based on the study design, it cannot be concluded that there is a correlation between the improved health status/quality of life and the self-management programme. For this purpose, a control group would be necessary to evaluate the programme’s effect on the health status and quality of life of people with rheumatic disease. Nevertheless, this pilot project represents an important foundation on which further services and programmes to strengthen self-management in rheumatology can be developed. Disclosure of Interests None declared